Natural Orifice Specimen Extraction Surgery Compared With Conventional Laparoscopy Treatment Of Colorectal Cancer:a Meta-analysis

Objective Colorectal cancer(CRC)is one of the most common malignant tumors in the world.With the development and application of surgical techniques,laparoscopic surgical techniques for colorectal cancer have gradually developed and matured,making great progress in terms of hospital stay and postoperative recovery.In recent years,the operation of Natural orifice specimen extraction surgery has developed rapidly,Its characteristics of incision-free surgery and the advantages of rapid recovery have attracted people’s attention.but there is still doubt about the safety and effectiveness of NOSES contrast CL.this paper meta-analyzes relevant clinical studies to systematically analyze the clinical efficacy of NOSES contrast CL in the treatment of colorectal cancer.Methods We compared published literature on Natural orifice specimen extraction surgery(NOSES)treatment of colorectal cancer with conventional laparoscopy(CL)in the electronic databases of Pub Med,Embase,Cochrane Library,CNKI,WANFANG Date Before December 2019.Relevant data were extracted through literature screening.Meta analysis was performed with Rev Man5.3,and Stata 15.0.Results A total of 27 clinical trials were enrolled,There were 6 randomized controlled trials and 21 non-randomized controlled trials,with a total of 3027 patients,including 1382 patients in the NOSES group and 1645 patients in the CL group.1.The mean operation time(MD=11.57,95%CI=3.66~19.48,p=0.004)was longer in the NOSES group than in the CL group,and the difference was statistically significant(p < 0.05).Intraoperative blood loss(MD=-9.25,95%CI=-14.67~-3.73,p=0.001)was less in the NOSES group than in the CL group,with statistical significance(p < 0.05).The number of lymph nodes dissected(MD=-0.22,95%CI=-0.71~0.27,p=0.38)in the NOSES group was not statistically different from that in the CL group.2.Mean length of stay(MD=-1.46,95%CI=-1.86~-1.05,p﹤0.00001),postoperative first exhaust time(SMD=-0.96,95%CI=-1.31~-0.61,p﹤0.00001),postoperative time of getting out of bed MD=-0.95,95%CI=-1.21 ~-0.69,p﹤0.00001),postoperative regular eating time(MD=-0.32,95%CI=-0.51~-0.12,p=0.002)patients in the NOSES group were all earlier than those in the CL group,with statistical significance(p < 0.05).3.Postoperative additional analgesic drug treatment(OR=0.28,95%CI=0.18~0.43,p﹤0.00001)significantly lower in the NOSES group than in the CL group,with statistical significance(p < 0.05).The pain score on the first day after surgery(SMD=-1.38,95%CI=-1.79~-0.97,p﹤0.00001)and the pain score on the third day after surgery(SMD=-1.20,95%CI=-1.66~-0.74,p﹤0.00001)were significantly lower in the NOSES group than in the CL group,with statistical significance(p < 0.05).4.The incidence of total postoperative complications(OR=0.45,95%CI=0.35~0.58,p﹤0.00001)was significantly lower in the NOSES group than in the CL group,with statistical significance(p < 0.05).In the subgroup of wound related complications(OR=0.16,95%CI=0.09~0.30,p﹤0.00001)and intestinal obstruction(OR=0.42,95%CI=0.21 ~ 0.84,p=0.01),the NOSES group was smaller than CL,which was statistically significant(p < 0.05).Leakage at the anastomotic site(OR=0.91,95%CI=0.59~1.39,p=0.67),abdominal infection(OR=1.24,95%CI=0.44~3.44,p=0.68),urinary retention(OR=0.99,95%CI=0.34~2.84,p=0.98),urinary tract infection(OR=0.72,95%CI=0.22~2.31,p=0.58),pulmonary infection(OR=0.50,95%CI=0.19~1.32,p=0.16)there was no statistical difference between the two groups in the subgroup(p≥0.05).5.The 3-year disease-free survival rate after surgery(OR=1.43,95%CI=0.84~2.42,p=0.18)was not statistically significant in the NOSES group compared with the CL group.Conclusions The NOSES group had a longer operation time than the CL group,but had greater advantages in intraoperative blood loss,mean hospital stay,postoperative exhaust time,postoperative out-of-bed activity time,postoperative regular diet time,and the incidence of postoperative complications was significantly lower than CL group.It indicates that the patients in the NOSES group have great advantages in postoperative recovery,which can reduce postoperative pain,reduce incision-related complications,and speed up postoperative recovery,which is safe,feasible and effective.